Medicine From The Trenches

Experiences from medical school, residency and beyond.

The Post-Match “Supplemental Offer & Acceptance Program (SOAP)

Introduction

In previous years, a process known as “The Scramble” existed for:

  • People who were unmatched on the Monday of Match Week
  • Unfilled residency programs
  • People who matched to an advanced position but not a first-year residency position.

The Scramble was also utilized as a primary residency application process for people who didn’t want to go though the Electronic Residency Application Service (ERAS) who often submitted their application materials via fax to programs who didn’t fill (from the list provided on the Monday of Match Week) or even contacted those programs via phone or e-mail. The Scramble does not exist any longer and programs who participate in the Match cannot accept applications outside ERAS. In short, the SOAP process is a different entity with hazards and plenty of opportunities for mistakes on the part of applicants.

SOAP is NOT “The Scramble”

Programs that participated in the Match are no longer allowed to interact with applicants outside of ERAS as this would be a violation of the Match participation agreement. This means that all applications to unfilled programs (those programs that are on the unfilled list) have to be submitted via ERAS. For programs, this means that e-mails, fax machines and phone lines are not jammed with people attempting to submit application materials. Frequently in previous years, many applicants (IMGs, FMGs in particular) could pay for a mass fax service to fax applications to every program on the unfilled list as soon as the Scramble opened which often jammed machines. Most residency programs were only interested in filling with desirable applicants who may not have matched (by mistake usually) and were not able to screen for those applicants because their fax machines, e-mails and phone lines were jammed.

SOAP should not be your primary residency application

If you are seeking a residency position in the United States, you need to meet the deadlines for ERAS with your application materials. In short, you need to submit your application materials (to your medical school if you are an American grad or to ERAS if your are an FMG/IMG) and participate in the regular Match.  If you are an applicant with problems such as failures on any of the USMLE Steps or failures in medical school coursework, do not make the mistake of believing that unfilled programs are desperate and will take a chance on you rather than remain unfilled. First, there are far more applicants in the regular match than ever before. Many people who will find themselves unmatched either overestimated their competitiveness for a program or were just below the cutoff for a program to rank. If a program interviewed you but you didn’t make the cutoff for them or you didn’t rank them at all, you have a better shot at securing a position in that program through SOAP than an applicant who didn’t interview at all. Programs would rather take an applicant that they have seen and interviewed rather than just a person on paper (which is why trying to use the SOAP rather than the Match is a poor strategy).

You are limited to an absolute maximum of 45 programs in the SOAP

In the SOAP, your maximum is 45 programs. You can apply to 30 programs during the first cycle (Monday) and 10 programs during the second cycle (Wednesday) and 5 programs on the third cycle (Thursday).  Applications do not roll over so that if you don’t get a match by the third day the start of the second cycle, you are likely not going to find much out there. There are more applicants who will be unmatched (because there are more people participating) thus the positions will go quickly because programs can review applications to chose the most desirable candidates with the SOAP system.

If you have problems that prevented you from getting any interviews in the regular Match season or you didn’t get enough interviews to find a Match, then you are going to be less likely to find a position in the SOAP. This means that you won’t have a position for residency. If this happens (you know if you have academic or USMLE/COMLEX problems), have a contingency plan in place. This means that rather than sitting around wishing, hoping and praying while your classmates and colleagues are going on interviews, you need to be looking at alternatives to residency that will enable you to earn a living and alternatives that will enhance your chances of getting a position in the next Match.

Strategies to enhance your chances of getting a PGY-1 position

If you know that you are a weaker candidate (failure on USMLE/COMLEX Step I, failure in medical school coursework, dismissal from medical school and readmission), then don’t apply to the more competitive specialties. Don’t apply to university-based specialties in the lesser competitive specialties and apply to more rather than less programs. If you have academic problems, you are likely not going to match in Radiology, Opthalmology, Dermatology, Emergency Medicine, Radiation Oncology or Anesthesiology. You are likely not going to match in university-based programs in Surgery or any of the surgical specialties, Psychiatry, Pathology, OB-GYN,Neurology, Physical Medicine and Rehabilitation, Family Medicine or Internal Medicine. In short, community-based programs in Family Medicine and Internal Medicine may be your best options.Do not believe that if there are unfilled positions in programs that are university-based or competitive, that you are going to snag one of those positions in the SOAP. A majority of those programs would rather go unfilled than fill with a less desirable applicant (in spite of what you hear, those programs are not desperate enough to take any applicant just to fill).

If you are an IMG/FMG, you have to meet the requirements for application which means that your USMLE Scores likely will have to be higher than those for American grads and you can’t have any USMLE failures. There are also cutoffs in terms of year of graduation from medical school for many programs. In short, you need to look at the application requirements for any residency program that you apply to and make sure that you are eligible (better yet, that you exceed) those application requirements.

The best resource for estimating your competitiveness for a particular specialty is to look at the previous years  National Residency Matching Program ( NRMP) reports for those specialties. You can look at the characteristics for matched and unmatched individuals to see where you fit. With a greater number of medical school graduates (most American medical schools increased their class sizes) and the number of residency positions staying static, there are fewer positions out there to be filled. There will be fewer position in the SOAP and the competition for those positions will be greater. Since the competition in the SOAP is greater, it is best to avoid having to use that system all together if possible.

If you know that you are a weaker candidate, apply for preliminary (not transitional) positions in either Internal Medicine or Surgery. You will stand a better chance of getting a preliminary position (more available) and you will have a job where you can demonstrate your clinical abilities for one year before you re-enter the Match for the next year. If you do a good job in your preliminary year, score high on the in-training exams and perform at a high level clinically, you may be able to secure a categorical second-year position in the same program where you do your preliminary position or you may position yourself to become more competitive for another specialty at another institution. The upside to this strategy is that you will not be relying on the SOAP as a primary means of residency application but the downside is that you have to be ready to perform extremely well in your preliminary position without exception. In short, getting into a preliminary position can be a huge asset if you are ready to work hard and prove yourself but can be a huge liability if you are not ready for clinical residency and perform poorly.

Things that generally DO NOT enhance your chances of matching

Doing graduate degree work if you do not match will generally not help your chances of matching. If you can complete a graduate degree (such as an MPH), you may enhance your chances but most graduate degree programs close their application submission dates before you know whether or not you have matched. If you anticipate that you are not going to match, then apply for graduate school long before Match Week or you will find that you can’t get into graduate school. Additionally, you need to complete your degree before the clinical year starts after the next Match. This means that you have to be able to ensure on your next ERAS application, that you will complete all of your degree requirements by the start of your PGY-1 year. Again, if you know that you have a high change of not matching, get your graduate school application done ahead of time or better year, delay entering the match and just apply for graduate school outright (can’t do a Ph.D) but plan on spending no more than one year away from clinical medicine.

Hanging out and “schmoozing” with residency attendings if you are not in their residency program is generally a waste of time. Doing additional observerships (IMG/FMG) generally will not help you if you have done enough before you applied. Working in “research” will generally not help you unless you already have an advanced degree (MS or Ph.D)  or you are able to produce a major paper or article for a national or international peer-reviewed journal. When I say produce, I mean first author not just run a few experiments  or enter data. If you can get yourself on a major clinical research project where you are actually gathering some clinical experience, you can use this to enhance yourself for residency but you face stiff competition for these types of projects and you need an unrestricted license to practice medicine (difficult to obtain without a passing score on USMLE Step 3 + 1-2 years of residency training).

Summary

Making sure that you match requires a bit of strategy and planning for everyone but for some applicants it will be a difficult process.

  • People who have academic and USMLE/COMLEX problems will have even more problems getting into a residency
  • It is important NOT to rely on the SOAP as a primary means to apply to residency programs because you put yourself at a distinct disadvantage in terms of the number of programs that you can apply
  • You need to make sure that you are even eligible for the SOAP in that you have to have applied to the Main Residency Match (at least one program) and are fully or partially unmatched.

Learn as much about the process as possible as soon as possible. The decisions that you make in the residency application process can profoundly affect your career in medicine. Educate yourself about all aspects of the process as there is little room for error.

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29 November, 2013 - Posted by | applying for Residency, Match Day, residency, scramble, USMLE

28 Comments »

  1. Hello, I am a 4th year at a US based medical school. I had some test taking struggles with Step 2CK. I failed it the first time and re-took it with a 243. My Step 1 score was 212 on the first attempt. I also didn’t honor any clerkships, no AOA, just some outstanding letters and glowing clinical evaluations. I applied for general surgery categorical and prelim and didn’t match. I applied to 45 programs in the SOAP, all in surgery categorial and prelim and haven’t heard anything from any of the programs today. I am anticipating not seeing any offers tomorrow. I am now wondering what I should do. Thank you!

    Comment by Anonymous | 14 March, 2017 | Reply

    • To Anonymous,
      You need to look into applying for any prelim positions that are out there. If you don’t find something on the second day, then look into finding a research position where you can get some experience. You also want to be at your medical school since Deans of Medical school can communicate with Program Directors whereas you may not. Get in touch with you medical school to let them know that you are unmatched. If a VISA falls through, you may be able to get into that position but they need to know about you. In the meantime, scout out research positions, preferably at your medical school so that you can continue to look for positions. Lot’s of changes happen around Match Day and in the week or two after Match Day. Importantly, don’t lose hope but be proactive and communicate. Put emphasis on maintaining a strong work ethic which is far more important than grades and test scores right now. Good luck

      Comment by drnjbmd | 15 March, 2017 | Reply

      • Thank you for your response. I went through the SOAP with no offers. I also went through the post-SOAP “scramble” without any luck yet. Now I have to decide whether to defer graduation in order to apply to the match again in September. I am currently in a competitive research fellowship and really want some clinical experience. Also, would I have a shot at anything but family med or psych next match cycle, given my records and no prelim/TY or clinical experience this year after not matching?

        Comment by ANON | 18 March, 2017

  2. Hello,
    I’m IMG US-permanent resident, I did my residency (MD) in the EM in my country, I’m EM a fellow in BIDMC-Harvard medical school, actively researcher
    I had 238,242,first pass USMLE scores.
    I want to know what are my chances for the residency in the EM?
    What should I do to increase my chances?

    Best regards

    Comment by mohammed alsabri | 13 March, 2016 | Reply

  3. Hi, I am an IMG, passed step 1 and step 2ck at 2nd attempt. Passed step 2 cs at 1. Attempt. No interviews yet. Year of graduation is 2009. 1 month observer ship here in the us. 2 good lors from my home country. Do I have any chances in the SOAP? Categorical or prelim? What can I do to apply next year with better chances? Step 3? Externships? MPH? Please help… Thanks

    Comment by C. Them | 17 January, 2016 | Reply

    • To C.Them:
      First of all, there are a shortage of residency slots in this country. Even graduates of American medical schools with strong USMLE scores are going unmatched because there are more graduates than training slots. Second, you have some deficiencies in that you struggled with some of the USMLE steps. As an IMG, those struggles put you at a distinct disadvantage. Third, trying to rely on the Supplemental Offer & Acceptance Program (SOAP) is not going to be a sound strategy for obtaining a residency slot. Finally, your year of medical school graduation (2009) is becoming a bit remote in that most residency programs want graduates who have graduated in the last 3-5 years. I can’t say what your chances are in terms of getting a coveted residency slot as your chances depend largely on specialty, competitiveness (grades, USMLE steps) and numbers of slots available. Long gone are the days when there were extra slots that IMGs could even compete for. Since residency slots are financed by US Federal Government funding, American grads are going to be considered first. Additionally, residency programs are discouraged from making offers outside of the Match because they must offer all or none of their slots within the Match. Most programs have elected to fill within the Match. I can’t say that an MPH is going to make you anymore competitive. I can definitely say that every year you don’t get a slot, will count against you. I can also say that attempting to use the SOAP like the archaic “Scramble” doesn’t work any more. Good luck- Drnjbmd

      Comment by drnjbmd | 17 January, 2016 | Reply

  4. I am an IMG (Carribean med school grad), got a 210 on STEP1, 234 on CK (Just received my score last week) and Passed CS, all on the first attempt. I applied to family medicine and have not received any interviews yet. What are my chances on the SOAP?

    Comment by ttttii | 3 December, 2015 | Reply

    • See reply to previous post

      Comment by drnjbmd | 3 December, 2015 | Reply

  5. Hello, I entered the match this year but have not received any interviews. I am an IMG (Carribean med school), graduate in April 2016, non US citizen, Step 1 score of 210, just received my CK results last week 234 both on first attempt, also passed CS on first attempt. Applied for family medicine although i really want IM/Peds, I figured with my CK not available at the time ERAS opened, i did not stand a chance so I applied to Family medicine. What do you think about my chances in the SOAP?

    Comment by ttttii | 3 December, 2015 | Reply

    • To ttttii:
      If you haven’t received any interviews at all, your chances in the SOAP are not great. The problem is that there are far more graduates especially American grads than positions. This means that your best shot will be at programs that don’t fill but have interviewed you. The SOAP is not the “scramble” where you could apply to all empty programs. You are going to be limited in the number of positions that you can apply for. If you don’t get any interviews, the SOAP is your next alternative but have a Plan C in case nothing pans out. Good luck.

      Comment by drnjbmd | 3 December, 2015 | Reply

  6. I am an IMG with US clinical experience and am a US citizen (no J visa needed). I hg a 199 on Step I and 222 on Step II. I have applied for both preliminary and categorical general surgery. So far I have received only 2 preliminary interviews. My letters of rec are very strong, as is the rest of my application. Currently, I am emailing and calling my top programs of interest, with focus on regional/community programs. What are my chances of gaining more interviews at this time? What are my chances of matching preliminary? Do you think I will go to the SOAP? If I do, what are my chances in the SOAP? Also, in the SOAP, can you scramble for a position outside of the specialty you originally applied for??

    Comment by GenSurgHope | 10 November, 2015 | Reply

    • To GenSurgHope
      Please know that there is NO SCRAMBLE. Make sure you know the complete rules of the SOAP process. If you have only 2 interviews, you need to apply to more programs as your chances of a match are not good. Apply to as many as you can afford to try to secure more interviews. As an IMG (regardless of citizenship), you need more interviews. Good luck

      Comment by drnjbmd | 10 November, 2015 | Reply

  7. I am an IMG with US clinical experience and am a US citizen (no J visa needed). I hg a 199 on Step I and 222 on Step II. I have applied for both preliminary and categorical general surgery. So far I have received only 2 preliminary interviews. My letters of rec are very strong, as is the rest of my application. Currently, I am emailing and calling my top programs of interest, with focus on regional/community programs. What are my chances of gaining more interviews at this time? What are my chances of matching preliminary? Do you think I will go to the SOAP? If I do, what are my chances in the SOAP? Also, in the SOAP, can you scramble for a position outside of the specialty you originally applied for?

    Comment by GenSurgHope | 10 November, 2015 | Reply

  8. I am an IMG from India. Step 1(229);step 2CK(227) both on first attempt. Not taken CS yet, planning to take in November. Already applied for 2015-2016 match. No interviews yet. Will have CS result by the time of ranking. My question is if I do not get not even one interview by January and if apply in SOAP 2016, what are the chances of me getting matched in a program which did not interview me at all.?

    Comment by Need to match | 6 October, 2015 | Reply

    • To Need:
      Your chances are not very good if you are relying on SOAP. Have a back-up plan and know the process well. There are not many positions out there in SOAP because many places that previously might not fill, have found that they are filling. Have a good back-up plan in case of non-match.

      Comment by drnjbmd | 7 October, 2015 | Reply

  9. hello,
    Im an Indian IMG.step 1 score 204.will give ck in december and cs is scheduled for february 2016.I was thinking to give a chance in SOAP match.Have 1 patent and 2 publications in international journal.1.5 year passed to graduation.WHat you advice? should i give a try for soap by getting good ck scores or give step 3 and apply for match 2017?

    Comment by dr.blooom | 26 September, 2015 | Reply

    • To dr.bloom:
      Remember, you are not eligible for the S.O.A.P unless you enter the regular match and not match. Good luck!

      Comment by drnjbmd | 26 September, 2015 | Reply

  10. Can I apply for prelim and designate my interest as internal or emergency medcine?

    Comment by JustShobs | 14 September, 2015 | Reply

    • To JustShobs:
      When you apply to Prelim medicine, you apply to Medicine. As a prelim, you don’t have a “designation”, unless you match into an advanced position at the same location as your prelim position. As a prelim, you are likely going to be noncategorical which means that you won’t continue in that program after one year.

      Comment by drnjbmd | 14 September, 2015 | Reply

  11. I am a US citizen IMG (med school in India) with a Step 1 score of 243, first attempt pass on CS. I am taking step 2 ck by oct31 and I will have my score by mid November. I am interested in doing RAdiology and I dont have any clinical experience yet. I graduated may 2014. I am applying this match for both Radiology as well as 50+ prelim medicine positions. What i’m hoping is to do well clinically and get involved in some Radiology research and projects during my prelim year to spruce up my application for the next match in case i don”t match into rads this year. But again I may have a year in the middle again if I get rads next year. What can I do about that? Can I do another prelim year? Also, what is my chance of matching into Prelim medicine this year?

    Comment by Shobana Iyer | 13 September, 2015 | Reply

    • To Shobana Iyer,
      It’s tough for everyone out there. Rads is pretty competitive even for AMGs. Yes, you can do another prelim medicine year but this is not optimal as you do not want to be too many years out of medical school, thus do everything (including getting some clinical work this year) to match ASAP- Good luck

      Comment by drnjbmd | 13 September, 2015 | Reply

      • Hi so do you think I can match into prelim medicine this year with my Ck score coming in a bit late. I want to match into prelim instead of sitting at home and I’m planning to take research, observerships, and whatever else by Nov the min after I finish my ck . I have applied to about 30 programs. Can you recommend any programs where I may have a good chance??

        Comment by JustShobs | 13 September, 2015

      • Hi thank you so much for your speedy reply. Do you think my chances of matching into a prelim year are good with my Ck scores coming in a bit late (mid november?)?

        Comment by JustShobs | 13 September, 2015

      • To JustShobs:
        Research programs carefully but as an IMG, your best chances of any match come with you meet and exceed any deadlines. Many AMGs went unmatched, no preliminary programs or categorical programs which means that no programs are “beating the bushes” for applicants. As an IMG, it’s going to be tough. Good luck.

        Comment by drnjbmd | 14 September, 2015

  12. Would it still be possible to match radiology or general surgery after taking a leave of absence in the first year of medical school assuming above average performance on everything after the leave was over? Thanks for making this amazing website!

    Comment by RGS | 6 April, 2014 | Reply

    • To RGS:
      It depends on the reason for the LOA. You are going to be asked on ERAS if your medical school was extended longer than 4 years and you will be asked to provide a reason. If your LOA was illness (personal or family) and then totally resolved,then not much of a problem. When you state “above average”, you need to be well “above average” to match into strong university programs in surgery or radiology as these are competitive. If you are an IMG or an osteopathic medical grad, you need to be well-above average because these two specialties are not known for matching many DOs or IMGs.

      Comment by drnjbmd | 6 April, 2014 | Reply

  13. I have multiple attempts on Step 1. Passed CK & CS on first attempts. Didn’t match this year, this was my first time applying. Studying for step 3. IMG, US citizen. I am thinking about doing MPH. I have excellent LORs (Rush, Northwestern etc.). I was always a good student but life thew me some curve balls. Really confused as to how to further proceed and enhance my chances for residency?! Do more electives for contacts? I know several students in my positions who matched (mostly with contacts though). If I ever get a IM prelim, I know I will excel, but getting that first foot in the door seems almost impossible right now. Any guidance is much appreciated. TY

    Comment by I.M. | 18 March, 2014 | Reply

    • To I.M.:
      If you can find an MPH program that hasn’t closed applications (most deadlines were in April) the apply but make sure that you have completed all degree requirements before the Match next year. You can try to find a research position but these won’t help your cause much because you generally will not be doing anything clinical which is what programs need to see. If you can find someone who will allow you to function clinically (once you pass Step 3), then you can help yourself. I am pretty sure that you IMG status + multiple attempts on Step I is killing you right now. This is why you are going to need someone to advocate for you (residency program director type). Good luck.

      Comment by drnjbmd | 18 March, 2014 | Reply


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